scholarly journals Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations

2018 ◽  
Vol 121 (4) ◽  
pp. 768-775 ◽  
Author(s):  
P.J.D. Andrews ◽  
V. Verma ◽  
M. Healy ◽  
A. Lavinio ◽  
C. Curtis ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Consensus Recommendations

scholarly journals Intravenous thrombolysis with 0.9 mg/kg alteplase for acute ischaemic stroke: a network meta-analysis of treatment delay

2019 ◽  
Vol 96 (1141) ◽  
pp. 680-685
Author(s):  
Xi Chen ◽  
Yu Shen ◽  
Chengfang Huang ◽  
Yu Geng ◽  
Yunxian Yu
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Meta Analysis ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Treatment Delay ◽  
Cochrane Library ◽  
Randomised Controlled ◽  
Symptomatic Intracerebral Haemorrhage

ObjectivesThe aim of this study was to evaluate the effect of alteplase in intravenous thrombolysis of acute ischaemic stroke (AIS) regarding the different time windows of treatment (<3 hours, 3–4.5 hours, >4.5 hours).MethodsA systematic literature search was conducted from PubMed, Cochrane Library and Embase. 12 clinical randomised controlled trials with 3402 patients with AIS met the inclusion criteria. The primary, secondary and tertiary outcomes were modified Rankin Scale (mRS) scores 0–1, mortality at 90th day after treatment and symptomatic intracerebral haemorrhage within 36 hours, respectively. Network meta-analysis and conventional meta-analysis were carried out for calculating odds ratio (OR), the surface under cumulative ranking curve (SUCRA) and the probabilities of being the best.ResultsFor mRS, alteplase regardless of time delay was significantly more effective than placebo (OR 1.33–2.17). However, alteplase used within 3 hours after AIS occurrence (SUCRA=98.3%) was significantly more effective (OR=1.64) than that at 3–4.5 hours (SUCRA=43%) and showed the trend of priority (OR=1.47) compared with that beyond 4.5 hours (SUCRA=58%). For the mortality, compared with placebo (SUCRA=64.7%), alteplase within 3 hours was similar to that of 3–4.5 hours whereas alteplase beyond 4.5 hours (SUCRA=7.3%) showed the trend of significantly increasing 85% mortality. For the tertiary outcome, alteplase within 3 hours (SUCRA=19.0%) was comparable with placebo (SUCRA=99.9%) whereas alteplase beyond 3 hours significantly increased (OR 5.89–6.67) the symptomatic intracerebral haemorrhage.ConclusionsAlteplase within 3 hours should be recommended as the best treatment delay for its best efficacy among all the intervention and equivalent safety compared with placebo. Alteplase beyond 3 hours was less effective compared with that within 3 hours and increased the risk of mortality on 3 months as well as symptomatic intracerebral haemorrhage at 36 hours. More head-to-head clinical trials are needed to confirm those findings.

Cerebral haemorrhage

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Ischaemic Stroke ◽  
Brain Imaging ◽  
Intracerebral Haemorrhage ◽  
Cerebral Haemorrhage ◽  
Neurological Disability

This chapter covers the several types of cerebral haemorrhage: extradural, subdural, subarachnoid, and intracerebral. Subarachnoid haemorrhage (SAH) is an important cause of neurological disability and mortality, although only occasionally present with focal stroke symptoms. Intracerebral haemorrhage usually presents with a stroke, which can only be reliably distinguished from ischaemic stroke by brain imaging. The chapter discusses the diagnosis, investigation, and management of both SAH and intracerebral haemorrhage.

scholarly journals Rationale and design of the Registry of Acute Stroke Under Novel Oral Anticoagulants-prime (RASUNOA-prime)

2018 ◽  
Vol 4 (2) ◽  
pp. 181-188 ◽  
Author(s):  
Kirsten Haas ◽  
Jan C Purrucker ◽  
Timolaos Rizos ◽  
Peter U Heuschmann ◽  
Roland Veltkamp
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Vitamin K ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Emergency Treatment ◽  
Clinical Course ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Stroke Patients

Background Anticoagulation with vitamin K antagonists and non-vitamin K antagonists oral anticoagulants (NOAC) is effective in stroke prevention in patients with atrial fibrillation. However, anticoagulation also poses a major challenge for emergency treatment of patients suffering ischaemic stroke or intracerebral haemorrhage. Aim The registry RASUNOA-prime is designed to describe current patterns of emergency management, clinical course and outcome of patients with atrial fibrillation experiencing an acute ischaemic stroke or intracerebral haemorrhage under different anticoagulation schemes prior to stroke (NOAC, vitamin K antagonists or no anticoagulation). Methods and design RASUNOA-prime (ClinicalTrials.gov, NCT02533960) is a prospective, investigator-initiated, multicentre, observational cohort study aiming to recruit 3000 patients with acute ischaemic stroke and atrial fibrillation, and 1000 patients with acute intracerebral haemorrhage and atrial fibrillation with different anticoagulation schemes pre-stroke. It is a non-interventional triple-armed study aiming at a balanced inclusion of ischaemic stroke and intracerebral haemorrhage patients according to the different anticoagulation schemes. Patients will be followed up for clinical course, management and outcome up to three months after the event. Findings in ischaemic stroke and intracerebral haemorrhage patients on NOAC will be compared with patients taking vitamin K antagonists or no anticoagulant pre-stroke. Study outcomes Primary endpoint for ischaemic stroke patients: occurrence of symptomatic intracerebral haemorrhage, for intracerebral haemorrhage patients: occurrence of secondary haematoma expansion. Secondary endpoints include assessment of coagulation, use of thrombolysis and/or mechanical thrombectomy, occurrence of complications, implementation of secondary prevention. Summary Describing the current patterns of early management as well as outcome of stroke patients with atrial fibrillation will help guide physicians to develop recommendations for emergency treatment of stroke patients under different anticoagulation schemes.

P2780Accuracy of electronic healthcare records for diagnosis of stroke types in a large community-based prospective cohort study in China

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I J Turnbull ◽  
R Clarke ◽  
Y Guo ◽  
A Hacker ◽  
C Kartsonaki ◽  
...  
Keyword(s):  
Cohort Study ◽  
Subarachnoid Haemorrhage ◽  
Diagnostic Accuracy ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Medical Records ◽  
Community Based ◽  
Health Records ◽  
Large Community ◽  
Stroke Type

Abstract Background and purpose Reliable assessment of the determinants of major pathological types of stroke is dependent on the accuracy of diagnosis in population-based studies. We evaluated the diagnostic accuracy of stroke types in a large community-based cohort study involving health records collected in China. Methods In 2004–08, >0.5 million adults aged 30–79 years were recruited from general populations of 10 diverse areas (5 urban, 5 rural) in China. During an approximate 7-year follow-up, 37,694 stroke cases had been reported by linkage to electronic health records from disease-specific and mortality registries and from national health insurance agencies. For all reported stroke cases, hospital medical records were retrieved systematically and relevant data extracted for subsequent adjudication by specialists using bespoke electronic platforms. Results Among all reported incident stroke cases, 80% were ischaemic stroke (IS), 17% were intracerebral haemorrhage (ICH), and 1% were subarachnoid haemorrhage (SAH). To date, medical records have been retrieved for 29,632 cases, with reports of stroke diagnosis verified by public health staff in 27,115 (92%) cases, of which 3,778 (14%) were secondary diagnoses. Evidence of neuroimaging was found in 92% of all verified stroke cases. Of 23,337 primary stroke cases sent for specialist adjudication, a diagnosis of pathological stroke type was confirmed in 19,718 cases with the positive predictive values being 82.4% (95% confidence interval [CI], 82.0% - 82.8%) for IS, 97.8% (97.6 - 97.9) for ICH, and 98.2% (98.1 - 98.3) for SAH. Overall, the strength of association of systolic blood pressure was over 6-fold greater for confirmed than non-confirmed stroke cases and was nearly 3-fold greater for confirmed ICH than IS cases. Diagnostic accuracy by stroke type Reported Retrieved Verified Adjudicated Confirmed Approximate 95% CI n n % n % n % n PPV, % IS 30,143 25,477 85 23,551 92 20,045 85 16,515 82.4 (82.0–82.8) ICH 6,484 3,486 54 3,079 88 2,919 95 2,854 97.8 (97.6–97.9) SAH 557 397 71 326 82 279 86 274 98.2 (98.1–98.3) Other 510 272 53 159 59 94 59 75 79.8 (79.4–80.2) IS indicates ischaemic stroke; ICH, intracerebral haemorrhage; SAH, subarachnoid haemorrhage; and PPV, positive predictive value. Conclusions The overall diagnostic accuracy of pathological stroke types obtained from hospital records in China is comparable to reports from Western populations. Despite advances in electronic healthcare records, reliable classification of stroke types requires clinical adjudication using additional relevant investigations. Acknowledgement/Funding Kadoorie Charitable Foundation, UK Wellcome Trust & National Natural Science Foundation and National Key Research and Development Program of China

scholarly journals Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chaohua Cui ◽  
Yanbo Li ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
Lijie Gao ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Low Dose ◽  
Intravenous Thrombolysis ◽  
Gastrointestinal Haemorrhage ◽  
Lower Percentage ◽  
Stroke Patients ◽  
Statin Group ◽  
Risk Of Bleeding

Abstract Background For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. Methods Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. Results The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS <  = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). Conclusion For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

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